Healthcare Provider Details

I. General information

NPI: 1598809097
Provider Name (Legal Business Name): GEORGETOWN PEDIATRICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 04/12/2023
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1162 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-6426
  • Fax: 502-868-9724
Mailing address:
  • Phone: 502-863-6426
  • Fax: 502-868-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. HORACE P. HAMBRICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-863-6426